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General NPI Number Information
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NPI Number | 1255505053
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Entity Type | Individual
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Provider Name | WISSAM JEAN HALABI M.D
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Gender | Male
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 221 STOCKTON BLVD. UC DAVIS MEDICAL CENTER
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City | SACRAMENTO
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State | CA
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Zip | 95817-1418
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Country | US
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Telephone | 214-820-2362
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Fax | 214-820-7272
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Provider Business Mailing Address
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Address Line | 2221 STOCKTON BLVD. ROOM 3104 UC DAVIS MEDICAL CENTER
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City | SACRAMENTO
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State | CA
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Zip | 95817-1418
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Country | US
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Telephone | 916-734-3229
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Fax | 916-734-7089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 122307
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 122307
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License Number State | CA
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